With More Veterans Needing Health Care, What Will The Cost Be?

Sloan Gibson, acting secretary of Veterans Affairs, spoke in Phoenix last week. After a visit to a VA hospital, he said additional resources were likely needed in the area. Nationwide, the number of veterans seeking health care has risen dramatically in recent years.

A new generation of American vets is home from war — about 2.6 million of them. And there are about 10 million older veterans, many from the Vietnam era, hitting their 60s, 70s or 80s. Taking care of both groups is getting expensive.

"If they can afford to pay for wars, they can afford to pay for the treatment after the wars," says Garry Augustine, with Disabled American Veterans. DAV and other private veterans' organizations draw up their own "independent budget" for the Department of Veterans Affairs every year.

"We've been saying it every year for the last 10 years in our independent budget, that the funding is not sufficient to sustain the demand," Augustine says.

The VA is dealing with a 50 percent increase in primary care visits in the past three years. During the same period, the department has increased the number of primary care doctors by just 9 percent.

Augustine says this points to the root of the recent scandals. The VA sets a goal on patient wait times, for example, but doesn't have the resources to meet it.

"We believe that over the last 10 years the VA has been underfunded to the tune of about $9 billion," he says.

A VA audit into the current wait-times scandal found that a lack of providers was the largest cause of delayed care. On a visit to the Phoenix VA hospital, the acting VA secretary, Sloan Gibson, said more resources are probably needed there.

But Republican Sen. Tom Coburn of Oklahoma says the VA needs to spend what it has more wisely.

"Money is not the problem at the Veterans Administration," says Coburn. "We've got four VA hospitals under construction right now that are [a billion dollars] over budget, $500 million over budget in Denver alone," Coburn said recently. "It's called competency. And what we have to do is demand accountability. There's plenty of money."

The VA has the second-largest budget in the government, at around $160 billion. Only the Pentagon's is larger, with a base budget of more than $500 billion; that rises to more than $600 billion when adding the war in Afghanistan, which is counted separately.

Coburn is not alone in making his claim. Lawmakers have been asking VA officials for years if they have enough money. They always say they do.

It's become sort of an unspoken understanding, says Phil Carter at the Center for a New American Security.

"There seems to be a consensus or a kind of detente that's emerged, which is that the VA will request a certain amount of money ... and the committees will give them a little bit less than that. And no one will question the fundamental assumptions in that budget, or ask: Is it too much or too little?" says Carter.

Carter says the budget debate is also about deficits and the role government should play, not just a line-by-line look at VA programs. The debate about VA funding is now a continuation of the political debate about whether the government should be involved in health care, he says.

The politics may slant the numbers to the left or right, but what if the numbers are wrong?

Carter points out that the current scandal involves VA hospitals passing bad data up to Washington.

"We don't know if the VA has enough money or not," says Carter.

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And I'm Melissa Block. Opinions about the VA are often contradictory. Surveys show veterans love the care, but loathe the red tape. Another contradiction is funding. Veteran service organizations and the employees' union say the VA doesn't have the budget it needs, but every time Congress asks, VA officials say, no thank you, we've got enough money. So which is it? NPR's Quil Lawrence tried to answer that question.

QUIL LAWRENCE, BYLINE: A new generation of American vets are home from war - about 2.6 million of them. An older generation of American vets are hitting their 60s, 70s or 80s - there's about 10 million of them. Taking care of both groups is getting expensive.

GARRY AUGUSTINE: If they could afford to pay for the wars they can afford to pay for the treatment of veterans after the wars.

LAWRENCE: That's Garry Augustine with Disabled American Veterans. DAV and other veteran service organizations draw up their own independent budget for the VA every year.

AUGUSTINE: We've been saying it every year, for the last 10 years, in our independent budget that the funding is not sufficient to sustain the demand.

LAWRENCE: Augustine points to facilities that need to be built or leased, especially as the baby-boom generation of veterans needs more and more care. The VA is dealing with a 50 percent increase in primary care visits over the past three years. In the same time, the department has hired only 9 percent more primary care doctors. Augustine says, that's the route of the recent scandals. The VA sets goals, on patient wait times for example, that it doesn't have the resources to meet.

AUGUSTINE: We believe that over the last 10 years, the VA has been underfunded to the tune of about $9 billion.

TOM COBURN: Money is not the problem at the Veterans Administration.

LAWRENCE: Tom Coburn, Republican of Oklahoma, says the VA needs to spend what it has more wisely.

COBURN: I'd remind you we have four VA hospitals under construction right now that are over budget - $500 million over budget in Denver alone. It's call competency. And what we have to do is demand accountability. There's plenty of money.

LAWRENCE: The VA does have the second-largest budget after the Pentagon. Coburn says there's plenty of fat. And lawmakers have been asking VA officials for years if they have enough money. They always say they do. It's become sort of an unspoken understanding, says Phil Carter at the Center for a New American Security.

PHIL CARTER: There seems to be a consensus or kind of detente that's emerged, which is that the VA will request a certain amount of money and the committees will give them just a little bit less than that. And no one will really question the fundamental assumptions in that budget or ask is it too much or too little?

LAWRENCE: That's because so many budget debates are also about deficits and the role of government, not just a line by line look at VA programs. In fact, Carter says the debate about VA funding is now a continuation of the political debate about whether the government should be involved in healthcare.

CARTER: Efforts to improve and build the VA will run into opposition based on a desire to minimize the role of government and healthcare. Efforts to strip the VA or shift functions to the private sector will run into a tense opposition for the vet's community, who believe that the VA represents the nation's brick and mortar commitment to its veterans. And so the politics are thoroughly intractable here.

LAWRENCE: Carter has a very unsatisfying answer to the question about whether the Department of Veterans Affairs has the money it needs or not. He doesn't know. Remember, this whole scandal is about VA hospitals passing bad data up to Washington. So maybe no one knows just how underfunded or overfunded the VA is right now. Quil Lawrence, NPR News. Transcript provided by NPR, Copyright NPR.